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DR. MARCUS HORWITZ, PROFESSOR OF MEDICINE AT THE University of California, Los Angeles, has devoted most of his career to finding a vaccine for tuberculosis. Though the age-old killer is well controlled in the industrialized world, TB kills more than 2 million people each year among the global poor. It's not a sexy field: Compared with funding for heart-disease, HIV/AIDS or cancer research, National Institutes of Health money for TB research is a minor blip. Applied research into potential TB cures and vaccines is not a priority for the agency, or for drug companies, which see no profitable market among the poor. Still, after 15 years of research funded mainly by the NIH, Horwitz's lab has finally come up with what could be the first improvement in TB vaccination technology in nearly a century. His vaccine is being tested among a small group of patients, and a nonprofit drug development organization funded by the Bill and Melinda Gates Foundation is committed to sponsoring the full-blown efficacy trials if his early experiment proves successful.

So why, on the cusp of real progress, is Horwitz's lab phasing out its basic science research on TB in favor of studying tularemia, the bacterium spread by ticks and rodents that causes rabbit fever? Because tularemia is on the government's A-list of potential bioterrorism agents, put there because the United States and the former Soviet Union stockpiled it as a biological warfare agent during the Cold War. Today, Washington is throwing plenty of money at basic research of the pathogen even though it affects only a few hundred Americans a year, is relatively rare around the world and is easily treatable with common antibiotics. Even if it did fall into the hands of terrorists, the threat would hardly be grave: The disease is difficult to weaponize and, when treated, is fatal in fewer than 2 percent of cases. "Scientists call it money transferase," says Horwitz. In his case, the $200,000 he's received annually to study one of the globe's most virulent killers, TB, will now mainly go to study a disease whose significance is primarily symbolic in the war on terrorism.

It's a scenario that's being played out across the country. Since the 200l attacks, Congress has poured billions into bioterrorism research aimed at developing vaccines and drugs to combat the most likely threat agents. Indeed, the amount of money being directed at bioterrorism defense will soon make it the second-largest (after cancer) results-oriented medical research program of the post-Cold War era. And that has led the tiny fraternity of research scientists who've devoted their lives to studying infectious disease to expand or alter their research priorities in order to tap into the huge pot of money the government has set aside for bioterrorism research. Dr. Richard Guerrant, director of the Center for Global Health at the University of Virginia, for example, has tailored a few of his grants to win biodefense funding. "[Y]ou adopt what you do to attract the resources that are necessary," he said, adding that several of his colleagues at the center have shifted their "whole approach to tularemia and anthrax because of the availability of funding."

The drive to protect the nation against potential bioterrorism agents is having a major impact on the entire medical-research establishment. Direct spending on bioterrorism research and development by the National Institute of Allergy and Infectious Diseases (the lead NIH agency in bioterrorism defense research) and the Department of Defense soared from an annual $250 million pre-anthrax attacks to well over $2 billion this year, turning it almost overnight into a larger program than HIV/AIDS was in its heyday. By comparison, the NIH last year spent less than $200 million on tuberculosis and malaria combined. Meanwhile, the rest of the nation's medical-research budget is facing its first restrictive environment in decades. The NIH's overall research budget will rise only at the rate of inflation next year--far below the double-digit increases of the Clinton years. …

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